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[ Home ](https://mdster.com) 2. [ Blog ](https://mdster.com/blog) 3. [ Study Tips ](https://mdster.com/blog?category=study-tips) 4. American Osteopathic Board of Emergency Medicine (Emergency Medicine Clinical Exam (Legacy)): Study Tips That Actually Help [ Study Tips ](https://mdster.com/blog?category=study-tips) American Osteopathic Board of Emergency Medicine (Emergency Medicine Clinical Exam (Legacy)): Study Tips That Actually Help ============================================================================================================================= How to build a clean, scorable chart portfolio and avoid the documentation mistakes that delay certification. [ MDster Editorial Team ](https://mdster.com/about) · Mar 21, 2026 · 7 min read · 126 [ Reviewed by Dr. Ali Ragab, MBBCH, MSc, MCAI ](https://mdster.com/medical-reviewers/dr-ali-ragab) [Editorial Policy](https://mdster.com/editorial-policy) | [Corrections Policy](https://mdster.com/corrections) [ Emergency Medicine Boards ](https://mdster.com/blog?tag=emergency-medicine-boards) [ Emergency Medicine ](https://mdster.com/blog?tag=emergency-medicine) [ Study Tips ](https://mdster.com/blog?tag=study-tips) [ AOBEM ](https://mdster.com/blog?tag=aobem) [ Chart Review ](https://mdster.com/blog?tag=chart-review) [ Osteopathic Certification ](https://mdster.com/blog?tag=osteopathic-certification) Share this article Share this post On this page 1. [ Understand what the examiner is really grading ](#understand-what-the-examiner-is-really-grading) 2. [ Build your case set strategically ](#build-your-case-set-strategically) 3. [ Audit every chart against the scoring rubric ](#audit-every-chart-against-the-scoring-rubric) 4. [ Assemble the packet like an examiner wants to read it ](#assemble-the-packet-like-an-examiner-wants-to-read-it) 5. [ Study Schedule Template ](#study-schedule-template) 6. [ Common pitfalls to avoid ](#common-pitfalls-to-avoid) 7. [ Key Takeaways ](#key-takeaways) 8. [ References ](#references-heading) On this page 1. [ Understand what the examiner is really grading ](#understand-what-the-examiner-is-really-grading) 2. [ Build your case set strategically ](#build-your-case-set-strategically) 3. [ Audit every chart against the scoring rubric ](#audit-every-chart-against-the-scoring-rubric) 4. [ Assemble the packet like an examiner wants to read it ](#assemble-the-packet-like-an-examiner-wants-to-read-it) 5. [ Study Schedule Template ](#study-schedule-template) 6. [ Common pitfalls to avoid ](#common-pitfalls-to-avoid) 7. [ Key Takeaways ](#key-takeaways) 8. [ References ](#references-heading) If you are preparing for the American Osteopathic Board of Emergency Medicine (Emergency Medicine Clinical Exam (Legacy)) the biggest mistake is treating it like Part I or Part II. This is not a multiple-choice test and it is not a simulated oral case. It is a portfolio-style review of your real emergency department practice, and as of March 2026 it applies only to candidates who were approved to sit for the Written (Part I) exam before September 1, 2013. Your job is to prove that your actual charts show safe care, sound judgment, and reliable documentation. [\[1\]](#cite-1 "Reference [1]") Understand what the examiner is really grading ---------------------------------------------- The board reviews de-identified emergency department records plus your supporting practice documents. Examiners score charts on **History, Physical, Testing, Treatment, Diagnosis, Disposition/Discharge, Overall, and Critical Errors**. That means your preparation should center on **chart selection and chart audit**, not broad content review alone. [\[1\]](#cite-1 "Reference [1]") Use this mindset shift immediately: - **Do not ask, “Was this an interesting case?”** Ask, “Does this chart clearly show my reasoning, reassessment, treatment, and disposition?” - **Do not lead with your strongest diagnosis list.** Lead with charts that are complete, legible, and easy to follow. - **Do not spend most of your time on question banks.** For this exam, question banks are secondary; your primary resource is your own documentation plus current EM guidelines for cases you may submit. > **Pro Tip:** A dramatic save with poor documentation is a weak submission. A well-documented moderate-acuity case often scores better because the examiner can actually see your clinical thinking. Build your case set strategically --------------------------------- The board requires **two identical sets of 20 de-identified cases**, drawn from **at least five separate dates within the prior 12 calendar months**. **At least eight** must be patients who were admitted or appropriately transferred, and **no more than two charts** can come from any one content category. Cases with the same diagnosis and/or procedure should not be duplicated. [\[1\]](#cite-1 "Reference [1]") That means you should not collect 20 charts and hope they work. Build a tracker with 25-30 possible cases, then narrow down. Your spreadsheet should include: - date of service - category - admit/transfer vs discharge - final diagnosis - major procedure, if any - documentation completeness - whether the chart shows reassessment and disposition reasoning Prioritize charts that demonstrate three things clearly: 1. **You recognized risk early.** Example: chest pain with documented differential and disposition logic. 2. **You adapted as data changed.** Example: abdominal pain with repeat exam and revised plan. 3. **You closed the loop safely.** Example: discharge chart with return precautions, follow-up, and patient instructions. For resources, use **departmental peer-review feedback, your hospital documentation standards, and current emergency medicine guidelines** for high-risk presentations. Those tools help you fix weak chart habits before submission. Audit every chart against the scoring rubric -------------------------------------------- Create a one-page audit sheet using the board's scoring domains: **History, Physical, Testing, Treatment, Diagnosis, Disposition/Discharge, Overall, Critical Errors**. Then review each candidate chart as if you were the examiner. [\[1\]](#cite-1 "Reference [1]") Ask these chart-specific questions: - **History:** Did you document red flags, time course, relevant negatives, and risk factors? - **Physical:** Does the exam support the acuity and differential, or does it look templated? - **Testing:** Did you justify what you ordered and avoid obvious omissions? - **Treatment:** Are interventions, reassessments, consultations, and response to therapy visible? - **Diagnosis:** Does the chart show a working differential, not just a final label? - **Disposition/Discharge:** Is the admit, transfer, or discharge decision explained and safe? - **Critical Errors:** If this chart were reviewed after an adverse event, would anything look dangerous or indefensible? Run a **weekly 90-minute chart audit session** with a trusted colleague. Ask them to mark any place where they cannot tell why you did what you did. Those blind spots are exactly what hurts portfolio exams. > **Pro Tip:** If your chart only makes sense because *you remember the case*, it is not ready. The chart must stand on its own. Assemble the packet like an examiner wants to read it ----------------------------------------------------- The board can delay grading if materials are incomplete, and charts that are not properly de-identified can be returned. Each case must include the required pieces: **physician chart, physician orders, patient age and sex, nurse's notes, lab results, EKGs, official radiology interpretations, and discharge instructions/receipt when relevant**. All identifiers must be removed, including **patient name, birth date, social security number, hospital name, and medical record number**. [\[1\]](#cite-1 "Reference [1]") Use this assembly checklist: - De-identify every page, not just the first page. - Put cases in a consistent order in both binders. - Tab and index each case clearly. - Confirm both binders are identical; the second binder is used if rescoring is needed. - Match your chart set to your other required documents: license, privileges letter, CME report, and six months of ED schedules. [\[1\]](#cite-1 "Reference [1]") If possible, have a **non-clinical reviewer** from medical records, compliance, or coding do one final de-identification sweep. They will catch identifiers physicians often miss. Study Schedule Template ----------------------- AOBEM lists quarterly submission deadlines of **March 31, June 30, September 30, and December 31**, and the current Clinical Exam fee is **$650**. Work backward from your target cycle; do not build this packet in the final week. [\[1\]](#cite-1 "Reference [1]") WeekFocusOutput1Read the rules and build your trackerMaster checklist + candidate chart list2Pull 25-30 possible chartsBroad case pool with categories marked3First audit passRemove weak, incomplete, or duplicate-type cases4Second audit pass with peer reviewerFinal 20 + backup charts5Gather supporting documentsLicense, privileges letter, CME, schedules6Build binders and do de-identification reviewTwo complete identical binders ready to send If you are still doing broad EM review, limit it to the diagnoses represented in your chosen charts. That keeps your reading tied to exam performance instead of becoming a generic board-prep exercise. Common pitfalls to avoid ------------------------ Most failures or delays come from **process mistakes**, not lack of emergency medicine knowledge. The common ones are predictable: choosing too many charts from one category, forgetting the minimum admitted/transfer cases, submitting incomplete records, relying on charts with weak reassessment or discharge instructions, and missing required non-chart documents. Incomplete cases are not graded until all materials are submitted, which slows the whole certification process. [\[1\]](#cite-1 "Reference [1]") A good rule: if a chart has sloppy timing, vague disposition language, missing consultant input, or templated physical findings that do not match the complaint, replace it. Key Takeaways ------------- This week, do these five things: - Build a tracker for **30 potential cases**. - Mark which cases satisfy the **8 admitted/transfer minimum**. - Create your own **rubric-based audit sheet** using the board's scoring domains. - Schedule one **peer chart-review session**. - Start collecting your **license, privileges letter, CME report, and six months of schedules** now, not later. [\[1\]](#cite-1 "Reference [1]") This legacy exam is very passable when you stop thinking like a test-taker and start thinking like a chart auditor. Be selective, be organized, and make your documentation easy to trust. That is what the examiner is looking for. References (5) ------------------ 1. 1. [ certification.osteopathic.org/emergency-medicine/certification-process-overview/specialty-certification-process/clinical-exam ](https://certification.osteopathic.org/emergency-medicine/certification-process-overview/specialty-certification-process/clinical-exam/) [↩](#cite-ref-1-1 "Back to text") 2. 2. Clinical Exam: American Osteopathic Board of Emergency Medicine, American Osteopathic Association 3. 3. Policies and Procedures of the American Osteopathic Board of Emergency Medicine (candidate handbook) 4. 4. Applications and Payment: American Osteopathic Board of Emergency Medicine 5. 5. 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